Provider Demographics
NPI:1659194256
Name:HERNANDEZ, CARMEN SARA (SW)
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:SARA
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:SW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:371 CALLE JOSE DE DIEGO
Mailing Address - Street 2:
Mailing Address - City:RIO PIEDRAS
Mailing Address - State:PR
Mailing Address - Zip Code:00929-0025
Mailing Address - Country:US
Mailing Address - Phone:787-620-5100
Mailing Address - Fax:787-250-0529
Practice Address - Street 1:371 CALLE JOSE DE DIEGO
Practice Address - Street 2:
Practice Address - City:RIO PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00929-0025
Practice Address - Country:US
Practice Address - Phone:787-620-5100
Practice Address - Fax:787-250-0529
Is Sole Proprietor?:No
Enumeration Date:2024-11-04
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11039104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker